The reliability and validity of doctor-recorded morbidity data in active data collection systems

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Abstract
To test the reliability and validity of morbidity data recorded by general practitioners (family physicians) on structured recording forms in active data collection systems. The consulting general practitioner recorded the problems managed at 347 video-taped doctor-patient contacts. Two observers independently viewed the video-tapes and completed a recording form for each. Problems were centrally coded, using the International Classification of Primary Care (ICPC). Primary health care. Overall distribution of the morbidity; positive agreement regarding the morbidity managed at matched contacts at three levels of specificity (chapter; chapter-component; specific rubric); agreement taking negative agreement into account using Cohen's Kappa. Overall distribution of morbidity did not differ between observers. Positive mean agreement was 78.8% at chapter level, 69.6% at chapter-component, and 55.9% at rubric level. Kappa statistics showed agreement better than chance in all chapters, but failed to reach significance at rubric level in three chapters. Morbidity data actively collected by GPs provide a reliable overview of morbidity managed in general practice. At a specific contact the morbidity recorded is reliable and valid at chapter level, and in most cases, at chapter-component level. At rubric level variance between practitioners in labelling the problem calls into question the validity and reliability of the data.